Precertification Representative – Remote in EST

Opportunities with Optum in the Tri-State region (formerly CareMount Medical, ProHEALTH New York and Riverside Medical Group). Come make a difference in the lives of people who turn to us for care at one of our hundreds of locations across New York, New Jersey and Connecticut. Work with state-of-the-art technology and brilliant co-workers who share your passion for helping people feel their best. Join a dynamic health care organization and discover the meaning behind Caring. Connecting. Growing together. 

This position is full time (40 hours/week) Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:30am – 5:00pm. It may be necessary, given the business need, to work occasional overtime. 

We offer 4 – 6 weeks of on-the-job training. The hours of the training will be aligned with your schedule. 

If you are located within Eastern Time Zone, you will have the flexibility to work remotely* as you take on some tough challenges.  

         

Primary Responsibilities:

• Manage administrative intake of members
• Work with hospitals, clinics, facilities and the clinical team to manage requests for services from members and/or providers
• Process incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles
• Assist the clinical staff with setting up documents/triage cases for Clinical Coverage Review
• Handle resolution/inquiries from members and/or providers

This is high volume, customer service environment. You’ll need to be efficient, productive and thorough dealing with our members over the phone. You also must be able to work a flexible schedule that includes evening hours.

             

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. 

Required Qualifications:

• High School Diploma / GED OR equivalent work experience
• Must be 18 years of age OR older
• 2+ years of customer service experience
• Experience with Microsoft Word, Microsoft Excel and Microsoft Outlook
  
• Ability to work full-time, Monday – Friday between 8:30am – 5:00pm including the flexibility to work occasional overtime given the business need

    

Preferred Qualifications:

• Experience working within the health care Industry and with health care insurance
• Experience working in a hospital, physician’s office or medical clinic setting
• A clerical or administrative support background
• Knowledge of ICD-9 and CPT codes
• Experience working in a call center

           

Telecommuting Requirements: 

• Reside within Eastern Time Zone
• Ability to keep all company sensitive documents secure (if applicable) 
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy. 
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.